Combination of camrelizumab with paclitaxel and cisplatin may become a new standard of first-line therapy for advanced and metastatic esophageal cancer

Leading experts discussed the experience of using immunotherapy in patients with difficult-to-treat cancers during the symposia “Eastern Wind of Change in Immuno-Oncology” and “Combined Treatment Methods in Patients with Head and Neck Tumors,” which were held as part of the St. Petersburg International Oncology Forum “White Nights.”

Immunotherapy has led to a noticeable improvement in cancer treatment results. The new generation of monoclonal antibodies that block the PD-1 receptor has been able to overcome the shortcomings and limitations of the first drugs in this class, said Evgeny Naumovich Imyanitov, MD, professor, Corresponding Member of the Russian Academy of Sciences, head of the scientific department of tumor growth biology at the N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health.

Thus, camrelizumab has advantages over other PD-L1/PD1 antagonist drugs with a similar mechanism of action. In particular, its use does not provoke a decrease in the number of antitumor T-lymphocytes, which helps maintain the dose of antibodies in the tumor and prevents hyperprogression. The affinity of camrelizumab for PD-1 glycosylated at N58 is 100 times higher than that of pembrolizumab. Selective and targeted binding allows for more effective inactivation of the modified PD-1 protein, the activity of which is increased in the tumor process.

According to the results of the ESCORT-1st study in patients with squamous cell carcinoma of the esophagus who received camrelizumab as first-line therapy, overall three-year survival increased by 2-fold (to 25.6%), and two-year progression-free survival rates increased from 3.4% with chemotherapy to 20.4%. Another study, ESCORT, demonstrated significant advantages of camrelizumab in the second-line treatment of esophageal cancer compared with chemotherapy: the risk of progression and death decreased, median survival increased from 6.2 to 8.3 months, and one-year overall survival reached 33.7% compared to 22.3%.

These results give hope for a complex cohort of patients with esophageal cancer, 50% of whom die in the first year after diagnosis of the disease, noted in her introduction Svetlana Igorevna Kutukova, MD, Professor of the Department of Dentistry, Surgical and Maxillofacial Surgery of the Federal State Budgetary Educational Institution of Higher Education “Pavlov First St. Petersburg State Medical University”, oncologist of Department No. 10 (Antitumor Drug Therapy) of the St. Petersburg State Healthcare Institution City Cancer Center.

The data obtained show that the combination of camrelizumab with paclitaxel and cisplatin could potentially become a new, highly effective option for the treatment of squamous cell carcinoma of the esophagus in the first line of treatment, emphasized Svetlana Igorevna Kutukova.

Nasopharyngeal cancer is another disease in which immunotherapy can significantly improve the prognosis of patients. This rare pathology often affects young people and is rarely detected in a timely manner: due to non-specific symptoms, such as nasal congestion, patients often seek help at late stages, said Svetlana Igorevna Kutukova. According to her, as a rule, chemoradiation therapy is used for this diagnosis, and when the disease progresses, immunotherapy is considered promising, in particular with the use of camrelizumab, which can significantly improve the survival without progression of patients with nasopharyngeal cancer.

In the DIPPER study, the use of camrelizumab in patients with nasopharyngeal cancer achieved a significant improvement in the indicators: event-free survival increased to 86%, the risk of progression or death decreased by 44%, and the overall three-year survival exceeded 90%. These data were presented by Zamira Akhmedovna Radzhabova, MD, Head of the Head and Neck Tumors Department of the N.N. Petrov National Medical Research Center of Oncology.

She noted that camrelizumab in combination with gemcitabine and cisplatin has already been included in the practical recommendations of the Russian Society of Clinical Oncology (RUSSCO) as the most preferred first-line treatment regimen for nasopharyngeal cancer, as well as esophageal cancer.

The number of studies confirming the effectiveness of camrelizumab is constantly growing, which once again confirms the importance of modern treatment methods for improving the prognosis of patients with difficult-to-treat oncological diseases.

Equally important is the organization of domestic production of drugs applicable in modern treatment methods. Currently, a project is being implemented to transfer the technology for the synthesis of the substance to implement a full cycle of Russian production of camrelizumab. The project is being implemented jointly by the Gamaleya National Research Center for Epidemiology and Microbiology and the Petrovax Pharm company, which registered camrelizumab in Russia in 2024.